It is easier to de-escalate with someone
you know and trust than with someone you either do not know and do not trust
or someone you know and do not trust.
“Relationship is the single most
important therapeutic modality for ameliorating threats of violence,
emotional crisis and the need for restraint. Peter Breggin, M.D., JCAHO
1999” (Quoted in Bowen, 2005.
In 2004 the National Association of State
Mental Health Program Directors (NASMHPD)
held a conference and published the proceedings under the title:
Moving From Coercion to Collaboration in Mental Health Services
(Pollack, 2004). In the introduction to the proceedings, David Pollack
wrote about (paraphrased) coercion, the apparent need to use physical force
and isolation, as the root cause in the vast majority of situations where
restraint and seclusion have been used. When systems focus on the
development of healthy relationships and prohibit the use of coercion, the
result will be a reduction in the use of restraint and seclusion.
This has been the focus of the Mandt System
which has provided training to service providers for over ten years.
In the middle part of the 19th century
(1825-1875) there were many instances in which people were literally set
free from the chains that bound them. The Charter of Sheppard-Pratt
Psychiatric Hospital in Baltimore, Maryland called for patients to be
treated compassionately, and forbade the use of pain. As a devout member of
the Religious Society of Friends (Quakers), Pratt wanted his non-violent
approach to be reflected in the work that was to be done in the Hospital.
This approach was seen in the work of Dorothea Dix, Philippe Pinel, and
With the advent of behavioral
models of psychology in the late 1800’s, the concept of using external
coercion for the good of the person (ALLEGEDLY) who could not make a
reasonable decision independently became the norm. The more professionals
became aware of the power of operant conditioning, the easier it became to
use that power. Human relationships in general society became more and more
coercive as the hierarchical structure of the bureaucracy became the norm
within the business community.
Northern Arizona University defines
Positive Behavior Support, in part, as a process of “continually moving away
from coercion.” There are times when coercion may be necessary to prevent
death or significant injury. There is never a reason to use coercion to
force “COMPLIANCE WITH A GOAL OR A REQUEST.” The people who are served in
human service “TREATMENT” settings have a high rate of trauma (NASMHPD,
1999, 2004) and the use of coercion also re-traumatizes that person.
Recovery from trauma is a journey
(Reagan, 2007), and to help people recover those of us who are in paid
relationship must be invited to participate in that recovery. They (WE?)
are the servants, and must understand their role. Finding ways to
continually move away from coercion as we journey towards the hope of
healing is difficult, but has some clear markers:
- Understanding that all
“challenging behavior” communicates an unmet need.
- Identifying that unmet need is
the first goal of the recovery.
- Partnering with the person to
change the environment first and then, if desired by the person, helping
the person learn new behaviors to help them meet their goals.
- Aligning the components of
human services to support the person’s recovery is critical to success.